CROI 2019: Interventions raise men’s HIV testing rates

Science Speaks is in Seattle this week covering breaking news in HIV research, policies and plans at CROI 2019 March 4-7.

SEATTLE – A financial incentive as small as a $3 voucher for food dramatically increases HIV testing in areas with high HIV infection rates but low rates of testing, researchers said here. In places where HIV testing and linkage to care among men remain low while new infections among women and deaths from HIV among men remain high, scaling up the use of such small incentives may be an effective tool in increasing the number of people who know their HIV status, Hae-Young Kim of the Africa Health Research Institute said.

Researchers in the Home-Based Trial to Test and Start – or HITS study – found that HIV testing was 55 percent higher among men who were provided with a food voucher worth $3 to take a home-based HIV test compared to men who didn’t receive an incentive, Ms. Kim said. As men are less likely to take an HIV test and know their status compared to women, Kim said, that difference is not only statistically significant, but could make a significant difference in treatment and prevention goals.

Researchers enrolled men in 45 communities in the KwaZulu Natal district in South Africa. With a quarter of the population living with HIV, KwaZulu Natal has the highest HIV prevalence in the country. Participants were placed into one of four arms: financial micro-incentive for HIV testing, male-targeted counseling delivered through an app on a tablet which encouraged men to do testing, both the micro-incentive and app-based counseling, and control arm with no interventions. Participants who were provided with a tablet were able to explore the app modules on their own time.

The incentive alone appears to have made the biggest difference with HIV testing increased by 55 percent in the arm that received only the micro-incentive and increased by 50 percent in the arm that received both interventions, Ms. Kim said.

Another study presented here that showed a significant increase in home-based HIV testing provided oral HIV tests to people living with HIV to give to their uninfected partners.

“Men continue to be a population we miss,” Kathryn Duval of the University of California Los Angeles said, “and self-testing may be one strategy to address this gap.”

People living with HIV who receive HIV treatment in Malawi are normally provided with referral slips to give to their uninfected partners to encourage HIV testing, Ms. Dovel said, but only 20 percent of uninfected partners seek testing after getting a referral slip. Ms. Dovel and colleagues provided study participants on HIV treatment with the Oraquick rapid oral HIV self-test and trained them on how to use it. Participants in the control arm were provided with the standard referral slip to give to their partners.

Researchers found that while over 90 percent of participants in both arms gave their partners the oral test or referral slip, 81 percent of uninfected partners who were given an oral self-test by their partners completed the test, compared to 29 percent of partners in the control arm who sought an HIV test, Ms. Dovel said.

Providing partners living with HIV a demonstration on how to use the oral test was instrumental, Ms. Dovel said. “Self-testing isn’t intuitive,” she said. “People do need guidance and help.”